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| Arnd Doerfler MD, PhD, studied at the University of Heidelberg and Zurich Medical School. Dr Doerfler trained in the Department of Neuroradiology at the University of Heidelberg from 1994 to 1997, and in the Department of Neuroradiology at the University of Essen from 1997–2004. In January 2005, Dr Doerfler will become Head of the Department of Neuroradiology at the University Erlangen-Nuernberg. He received Board Certification in Diagnostic Radiology in 2000, and in Neuroradiology in 2003. His MD thesis was on ‘Magnetic resonance imaging in acute experimental stroke’ and his PhD thesis on ‘Imaging and experimental therapy in acute MCA infarction’. Dr Doerfler’s research focus is interventional neuroradiology, the imaging and therapy of carotid artery disease and experimental research on cerebral ischaemia and epilepsy. Dr Doerfler has published more than 60 original papers and held more than 250 oral presentations. |
Carotid artery stenting without cerebral protection
Arnd Doerfler, Tobias Engelhorn
and Michael Forsting
Department of Neuroradiology, Diagnostic and
Interventional Radiology, University of Essen Medical
School, Essen, Germany
Address for correspondence:
Dr Arnd Doerfler, Department of Neuroradiology
Diagnostic and Interventional Radiology
University of Essen Medical School
Hufelandstrasse 55, D-45122 Essen, Germany
Tel: +49-(201)-723-1542
Fax: +49-(201)-723-5959
Email: arnd.doerfler@uni-essen.de
Abstract
Carotid angioplasty and stenting is increasingly used as an attractive alternative to carotid endarterectomy (CEA) for treatment of symptomatic and asymptomatic carotid artery disease. Results from observational, non-randomised studies describe excellent technical success and periprocedural complication rates similar to those of CEA. Technical success, patency and improved complication rates are mainly the result of substantial technical improvements, an improved associated learning curve, and the improved periprocedural anti-coagulation regimens.
Currently, controversies exist as to whether carotid angioplasty with stenting should be carried out with or without obligatory use of cerebral protection. In experienced hands, the use of protection devices can decrease complication rates. However, protection systems increase catheter time and technical complexity. Reviewing the literature, the combined stroke and death rate in protected carotid angioplasty with stenting is 2.0% compared with 3.2% in unprotected carotid angioplasty with stenting, which does not strongly support the use of protection devices. Additionally, scientific evidence for the mandatory
use of protection devices is lacking. Until the results of trials comparing CEA and carotid angioplasty with stenting are available, carotid artery stenting is indicated only in selected patients in an interdisciplinary approach and at high-volume centres, to obtain maximal patient benefit.
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